NR NR224 Final Exam Concept Blueprint NR 224: Final Exam Concept Blueprint A. Medication Administration Chapter 31 1.) 7 rights of medication administration

• Right Medication
• Right Dose
• Right Patient
• Right Route
• Right Time
• Right Documentation
• Right Indication

2.) How many times do you check medications prior to giving them? Describe each of those times and why it is needed?

• You should check meds 3 times.

3.) How to open packages skills procedure-from your book:

• Safety (ampules, needles)
  • Snap off ampule neck
  • Aspirate medication into syringe
  • Replace filter needle with appropriate size needles device
  • Admin injection
• Aseptic technique (vials)
  • If dry, use solvent or diluent as needed
  • Inject air into vial
  • Label multidose vials after mixing
  • Refrigerate remaining doses if needed
• Aseptic technique topical medications
  • Ask pts if they take any topical meds
  • When applying a transdermal patch, ask pt if they have an existing patch
  • Wear disposable clean gloves when removing and applying transdermal patches
  • If the dressing or patch is difficult to see, apply a noticeable label to the patch
  • Document patch or med location on the MAR and document the Removal
  • Checking packages for integrity/expiration date & proper labeling

4.) Factors affecting different routes of administration:

• Absorption
  • Absorption occurs when medication molecules pass into the blood from the site of medication administration. Factors that influence absorption are route of the administration (different rate of absorption), the ability of the medication to dissolve (depends largely on its form of preparation), blood flow to the site of administration (it will determine how quickly the body can absorb a medication), body surface area (it is absorbed at a faster rate), liquid solubility (highly lipid-soluble medications cross cell membranes easily and are absorbed quickly)
• Metabolism
  • After a medication reaches the site of action, it becomes metabolized into a less active or inactive form that is easier to excrete. Biotransformation occurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals.
• Distribution
  • After a medication is absorbed, it is distributed within the body to tissues and organs and ultimately to its specific site of action. The rate and extent of distribution depend on the physical and chemical properties of the person.
  • Circulation: once a medication enters the bloodstream, it is carried throughout the tissues and organs. How fast it reaches depends on vascularity. Patients with HF have impaired circulation, which slows medication delivery.
  • Membrane permeability: refers to the ability of a medication to pass through tissues and membranes to enter target cells. Blood-brain barrier allows only fat-soluble medications to pass into the brain and cerebral spinal fluid.
  • Protein binding: the degree in which medications bind to serum proteins such as albumin affects their distribution. Patients with liver disease or malnutrition have decreased albumin, which causes them to be at higher risk for medication activity, toxicity, or both.
• Elimination
  • After medications are metabolized, they exit the body through the kidneys, liver, bowel, lungs, and exocrine glands. Chemical makeup of a medication determines the organ of excretion.
  • Gaseous and volatile compounds such as nitrous oxide and alcohol exit through the lungs.
  • GI tract is another route for medication excretion. Factors that increase peristalsis accelerate medication excretion through the feces, whereas factors of slow peristalsis often prolong the effects of a medication.

5.) How to describe procedure for different routes of administration. Use the book skills procedure and rationale for all of these!!!

• Oral
  • Easiest and most desirable route
  • Food sometimes affects absorption
  • Protect patients from aspiration
  • Follow special precautions when administering medications to patients with enteral or small-bore feeding tubes
  • Follow tubing connection standards
  • Verify tube is compatible with medication absorption
  • Use liquid medications when possible
  • Flush between medications
• Sublingual
  • Administered under the tongue, sublingual pocket. Do not bite, let it dissolve.
• Buccal
  • Administered between cheek and molars.
• Ear in